Suppr超能文献

结缔组织病相关性间质性肺病患者的纵向研究及对霉酚酸酯和利妥昔单抗的反应

Longitudinal Study of Patients with Connective Tissue Disease-Interstitial Lung Disease and Response to Mycophenolate Mofetil and Rituximab.

作者信息

Li Yan, Mumtaz Sehreen, Baig Hassan Z, Mira-Avendano Isabel, Wang Benjamin, Rojas Carlos A, Stowell Justin T, Lesser Elizabeth R, Borkar Shalmali R, Majithia Vikas, Abril Andy

机构信息

Division of Rheumatology, Mayo Clinic, Jacksonville, FL 32224, USA.

Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.

出版信息

Diagnostics (Basel). 2024 Nov 30;14(23):2702. doi: 10.3390/diagnostics14232702.

Abstract

To investigate the effect of mycophenolate mofetil (MMF) and rituximab (RTX) on pulmonary function test (PFT) results in a mixed cohort of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD), longitudinally followed up for 1 year in a single academic center. Patients with CTD-ILD were identified in electronic medical records from 1 January 2009 to 30 April 2019. Prescribed MMF and RTX doses, dosage changes, and therapy plans were analyzed individually with improvement in PFT outcomes determined using multivariable linear regression models during 12-month follow-up. Forty-seven patients with CTD-ILD, treated with MMF, RTX, or both, were included. Patients on combined MMF and RTX had worse PFT outcomes at baseline compared with patients on monotherapy. Substantial improvement was observed among all PFT outcomes from baseline to 12 months, regardless of medication dosage or therapy plans. The diffusing capacity of the lungs for carbon monoxide (DLCO) worsened by an average of 7.21 mL/(min*mmHg) (95% CI, 4.08-10.33; < 0.001) among patients on RTX compared to combined therapy. Patients on higher doses of MMF at baseline experienced an average increase of 0.93 (95% CI, 0.04-1.82) units in DLCO from baseline to 6 months ( = 0.04) and a 2.79% (95% CI, 0.61-4.97%) increase in DLCO from 6 to 12 months ( = 0.02) within patients on concurrent RTX at 6-month follow-up. The treatment of CTD-ILD with MMF and/or RTX was associated with overall improvement in PFT outcomes. Combined therapy resulted in significant improvements in DLCO compared with monotherapy. Higher doses of MMF also provided greater improvements in DLCO.

摘要

为了研究霉酚酸酯(MMF)和利妥昔单抗(RTX)对结缔组织病相关间质性肺病(CTD-ILD)混合队列患者肺功能测试(PFT)结果的影响,在单个学术中心进行了为期1年的纵向随访。从2009年1月1日至2019年4月30日的电子病历中识别出CTD-ILD患者。分别分析MMF和RTX的处方剂量、剂量变化及治疗方案,并在12个月的随访期间使用多变量线性回归模型确定PFT结果的改善情况。纳入了47例接受MMF、RTX或两者治疗的CTD-ILD患者。与单药治疗患者相比,联合使用MMF和RTX的患者在基线时PFT结果更差。从基线到12个月,所有PFT结果均有显著改善,无论药物剂量或治疗方案如何。与联合治疗相比,接受RTX治疗的患者一氧化碳弥散量(DLCO)平均恶化7.21 mL/(min*mmHg)(95%CI,4.08-10.33;P<0.001)。基线时接受较高剂量MMF治疗的患者,在6个月随访时同时接受RTX治疗的患者中,从基线到6个月DLCO平均增加0.93(95%CI,0.04-1.82)单位(P=0.04),从6个月到12个月DLCO增加2.79%(95%CI,0.61-4.97%)(P=0.02)。MMF和/或RTX治疗CTD-ILD与PFT结果的总体改善相关。与单药治疗相比,联合治疗使DLCO有显著改善。较高剂量的MMF也使DLCO有更大改善。

相似文献

2
Rituximab in connective tissue disease-associated interstitial lung disease.
Clin Rheumatol. 2019 Jul;38(7):2001-2009. doi: 10.1007/s10067-019-04557-7. Epub 2019 Apr 23.
3
Mycophenolate mofetil improves lung function in connective tissue disease-associated interstitial lung disease.
J Rheumatol. 2013 May;40(5):640-6. doi: 10.3899/jrheum.121043. Epub 2013 Mar 1.
6
Rituximab for connective tissue disease-associated interstitial lung disease: A systematic review and meta-analysis.
Int J Rheum Dis. 2023 Feb;26(2):225-235. doi: 10.1111/1756-185X.14495. Epub 2022 Nov 15.
7
Long-Term Treatment With Azathioprine and Mycophenolate Mofetil for Myositis-Related Interstitial Lung Disease.
Chest. 2019 Nov;156(5):896-906. doi: 10.1016/j.chest.2019.05.023. Epub 2019 Jun 22.
8
Rituximab therapy in severe connective tissue disease associated interstitial lung disease: A retrospective single-centre observational study.
Afr J Thorac Crit Care Med. 2024 Oct 14;30(3):e1431. doi: 10.7196/AJTCCM.2024.v30i3.1431. eCollection 2024.
9
Cyclophosphamide for connective tissue disease-associated interstitial lung disease.
Cochrane Database Syst Rev. 2018 Jan 3;1(1):CD010908. doi: 10.1002/14651858.CD010908.pub2.
10

引用本文的文献

1
Fibrotic Hypersensitivity Pneumonitis: A Diagnostic Challenge Leading to Lung Transplantation.
Diagnostics (Basel). 2025 May 16;15(10):1267. doi: 10.3390/diagnostics15101267.

本文引用的文献

6
Clinical manifestations and treatment of antisynthetase syndrome.
Best Pract Res Clin Rheumatol. 2020 Aug;34(4):101503. doi: 10.1016/j.berh.2020.101503. Epub 2020 Apr 11.
7
Interstitial Pneumonia With Autoimmune Features (IPAF).
Front Med (Lausanne). 2019 Sep 27;6:209. doi: 10.3389/fmed.2019.00209. eCollection 2019.
8
Long-Term Treatment With Azathioprine and Mycophenolate Mofetil for Myositis-Related Interstitial Lung Disease.
Chest. 2019 Nov;156(5):896-906. doi: 10.1016/j.chest.2019.05.023. Epub 2019 Jun 22.
9
Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases.
Mayo Clin Proc. 2019 Feb;94(2):309-325. doi: 10.1016/j.mayocp.2018.09.002. Epub 2018 Dec 14.
10
Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline.
Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-e68. doi: 10.1164/rccm.201807-1255ST.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验